Burden of hospital-acquired SARS-CoV-2 infections in Germany: occurrence and outcomes of different variants

Bonsignore, Marzia; Hohenstein, Sven; Kodde, Cathrin; Leiner, Johannes; Schwegmann, Karin; Bollmann, Andreas; Möller, Robert; Kuhlen, Ralf; Nachtigall, Irit

doi:10.1016/j.jhin.2022.08.004

Cited by 12 publications

(18 citation statements)

References 36 publications

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“…3,20,21 The peak incidence of nosocomial infections following waves of high community transmission, with the highest peak observed in early 2022 due to spread of the Omicron variant, is in line with other reports. 3,22 This has implications for timely implementation of IPC measures to mitigate the spread of SARS-CoV-2 in hospitals such as through use of personal protective equipment or improved testing practices.…”

Section: Jama Network Open | Infectious Diseasessupporting

confidence: 90%

“…Previously, most studies have compared mortality in individuals with nosocomial vs community-acquired infections; however, since hospitalized patients have a substantial risk of death irrespective of SARS-CoV-2 infection, such comparisons do not accurately assess the excess mortality. 2,3 In our study, the 30-day mortality in the uninfected comparison cohort ranged from 10.3% to 11.4%, depending on the calendar period.…”

Section: Discussionmentioning

confidence: 61%

“…Additionally, studies analyzing nosocomial SARS-CoV-2 infections and the association with severe outcomes after the emergence of Omicron variants are scarce. [3][4][5] To account for underlying changes over time in SARS-CoV-2 incidence, prevalence, and changing population immunity to the virus, outcomes of nosocomial SARS-CoV-2 infections necessitate analyses among patients with similar characteristics and across different time periods during the pandemic. Such analyses, including risk quantification, may guide prevention efforts, including planning and implementation of infection prevention and control (IPC) measures.…”

Section: Introductionmentioning

confidence: 99%

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Nosocomial SARS-CoV-2 Infections and Mortality During Unique COVID-19 Epidemic Waves

Dave,

Sjöholm,

Hedberg

et al. 2023

JAMA Netw Open

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ImportanceQuantifying the burden of nosocomial SARS-CoV-2 infections and associated mortality is necessary to assess the need for infection prevention and control measures.ObjectiveTo investigate the occurrence of nosocomial SARS-CoV-2 infections and associated 30-day mortality among patients admitted to hospitals in Region Stockholm, Sweden.Design, Setting, and ParticipantsA retrospective, matched cohort study divided the period from March 1, 2020, until September 15, 2022, into a prevaccination period, early vaccination and pre-Omicron (period 1), and late vaccination and Omicron (period 2). From among 303 898 patients 18 years or older living in Region Stockholm, 538 951 hospital admissions across all hospitals were included. Hospitalized admissions with nosocomial SARS-CoV-2 infections were matched to as many as 5 hospitalized admissions without nosocomial SARS-CoV-2 by age, sex, length of stay, admission time, and hospital unit.ExposureNosocomial SARS-CoV-2 infection defined as the first positive polymerase chain reaction test result at least 8 days after hospital admission or within 2 days after discharge.Main Outcomes and MeasuresPrimary outcome of 30-day mortality was analyzed using time-to-event analyses with a Cox proportional hazards regression model adjusted for age, sex, educational level, and comorbidities.ResultsAmong 2193 patients with SARS-CoV-2 infections or reinfections (1107 women [50.5%]; median age, 80 [IQR, 71-87] years), 2203 nosocomial SARS-CoV-2 infections were identified. The incidence rate of nosocomial SARS-CoV-2 infections was 1.57 (95% CI, 1.51-1.64) per 1000 patient-days. In the matched cohort, 1487 hospital admissions with nosocomial SARS-CoV-2 infections were matched to 5044 hospital admissions without nosocomial SARS-CoV-2 infections. Thirty-day mortality was higher in the prevaccination period (adjusted hazard ratio [AHR], 2.97 [95% CI, 2.50-3.53]) compared with period 1 (AHR, 2.08 [95% CI, 1.50-2.88]) or period 2 (AHR, 1.22 [95% CI, 0.92-1.60]). Among patients with nosocomial SARS-CoV-2 infections, 30-day AHR comparing those with 2 or more doses of SARS-CoV-2 vaccination and those with less than 2 doses was 0.64 (95% CI, 0.46-0.88).Conclusions and RelevanceIn this matched cohort study, nosocomial SARS-CoV-2 infections were associated with higher 30-day mortality during the early phases of the pandemic and lower mortality during the Omicron variant wave and after the introduction of vaccinations. Mitigation of excess mortality risk from nosocomial transmission should be a strong focus when population immunity is low through implementation of adequate infection prevention and control measures.

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Section: Jama Network Open | Infectious Diseasessupporting

confidence: 90%

Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Nosocomial SARS-CoV-2 Infections and Mortality During Unique COVID-19 Epidemic Waves

Dave,

Sjöholm,

Hedberg

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

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“…However, the Omicron period had higher hospital-onset SARS-CoV-2 infection rates compared with the Delta period, potentially due to Omicron variant characteristics such as greater transmissibility and immune escape that, in turn, led to months of higher true community incidence . Studies have observed higher rates of hospital-onset SARS-CoV-2 infections associated with Omicron, which is potentially attributable to greater transmissibility, higher community incidence rates, or both. However, our study showed nonsignificant differences during the pre-Delta period and the Omicron period.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Hospital-Onset SARS-CoV-2 Infection Rates and Testing Practices in the US, 2020-2022

Hatfield,

Baggs,

Maillis

et al. 2023

JAMA Netw Open

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ImportanceCharacterizing the scale and factors associated with hospital-onset SARS-CoV-2 infections could help inform hospital and public health policies regarding prevention and surveillance needs for these infections.ObjectiveTo evaluate associations of hospital-onset SARS-CoV-2 infection rates with different periods of the COVID-19 pandemic, hospital characteristics, and testing practices.Design, Setting, and ParticipantsThis cohort study of US hospitals reporting SARS-CoV-2 testing data in the PINC AI Healthcare Database COVID-19 special release files was conducted from July 2020 through June 2022. Data were collected from hospitals that reported at least 1 SARS-CoV-2 reverse transcription–polymerase chain reaction or antigen test during hospitalizations discharged that month. For each hospital-month where the hospital reported sufficient data, all hospitalizations discharged in that month were included in the cohort. SARS-CoV-2 viral tests and results reported in the microbiology files for all hospitalizations in the study period by discharge month were identified. Data analysis was conducted from September 2022 to March 2023.ExposureHospitalizations discharged in an included hospital-month.Main Outcomes and MeasuresMultivariable generalized estimating equation negative-binomial regression models were used to assess associations of monthly rates of hospital-onset SARS-CoV-2 infections per 1000 patient-days (defined as a first positive SARS-CoV-2 test during after hospitalization day 7) with the phase of the pandemic (defined as the predominant SARS-CoV-2 variant in circulation), admission testing rates, and hospital characteristics (hospital bed size, teaching status, urban vs rural designation, Census region, and patient distribution variables).ResultsA total of 5687 hospital-months from 288 distinct hospitals were included, which contributed 4 421 268 hospitalization records. Among 171 564 hospitalizations with a positive SARS-CoV-2 test, 7591 (4.4%) were found to be hospital onset and 6455 (3.8%) were indeterminate onset. The mean monthly hospital-onset infection rate per 1000 patient-days was 0.27 (95 CI, 0.26-0.29). Hospital-onset infections occurred in 2217 of 5687 hospital-months (39.0%). The monthly percentage of discharged patients tested for SARS-CoV-2 at admission varied; 1673 hospital-months (29.4%) had less than 25% of hospitalizations tested at admission; 2199 hospital-months (38.7%) had 25% to 50% of all hospitalizations tested, and 1815 hospital months (31.9%) had more than 50% of all hospitalizations tested at admission. Postadmission testing rates and community-onset infection rates increased with admission testing rates. In multivariable models restricted to hospital-months testing at least 25% of hospitalizations at admission, a 10% increase in community-onset SARS-CoV-2 infection rate was associated with a 178% increase in the hospital-onset infection rate (rate ratio, 2.78; 95% CI, 2.52-3.07). Additionally, the phase of the COVID-19 pandemic, the admission testing rate, Census region, and bed size were all significantly associated with hospital-onset SARS-CoV-2 infection rates.Conclusions and RelevanceIn this cohort study of hospitals reporting SARS-CoV-2 infections, there was an increase of hospital-onset SARS-CoV-2 infections when community-onset infections were higher, indicating a need for ongoing and enhanced surveillance and prevention efforts to reduce in-hospital transmission of SARS-CoV-2 infections, particularly when community-incidence of SARS-CoV-2 infections is high.

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“…What we've seen when new SARS-CoV-2 variants emerge," Fuller continued, "are increases in infection rate, but not necessarily increases in hospitalisation or severe disease. 25 Adverse events experienced by people with MS after SARS-CoV-2 vaccination include short-term fatigue, headache, febrile symptoms, and injection site pain. 18 Larger studies including people with MS have not shown increased rates of new MS symptoms or symptom worsening following vaccination against SARS-CoV-2.…”

Section: Immune Responses To Sars-cov-2 Vaccines In People With Multi...mentioning

confidence: 99%

The Efficacy and Safety of SARS-CoV-2 Vaccinations in People with Multiple Sclerosis

Roberts¹

2023

EMJ Neurol

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While people with multiple sclerosis (MS) are not more likely to contract COVID-19, the incidences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19-related complications may be higher for people with MS who have comorbidities or who are taking certain disease modifying therapies (DMT). Robert Shin, Professor of Neurology at MedStar Georgetown University Hospital, Washington, D.C., USA, and Deborah Fuller, Department of Microbiology, University of Washington School of Medicine, and Associate Director of the Washington National Primate Research Center, Seattle, Washington, USA, first discussed why vaccinations against SARS-CoV-2 should be recommended to people with MS. They then discussed evidence that suggests that the antibody response following vaccination may be dampened in people taking some DMTs, especially those that deplete CD20+ B cells; however, T cell responses to vaccinations may also provide protection. There is also evidence that messenger RNA (mRNA) SARS-CoV-2 vaccines, as opposed to viral vector or recombinant protein subunit vaccines, and boosters may lead to a better antibody response. Vaccine responses vary between patients taking different sphinogosine-1-phosphate (S1P) receptor modulators, being low for fingolimod and high for next generation S1P receptor modulators. Overall, more studies of vaccine response and timing are needed to best update the guidelines for people with MS.

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Burden of hospital-acquired SARS-CoV-2 infections in Germany: occurrence and outcomes of different variants

Cited by 12 publications

References 36 publications

Nosocomial SARS-CoV-2 Infections and Mortality During Unique COVID-19 Epidemic Waves

Nosocomial SARS-CoV-2 Infections and Mortality During Unique COVID-19 Epidemic Waves

Assessment of Hospital-Onset SARS-CoV-2 Infection Rates and Testing Practices in the US, 2020-2022

The Efficacy and Safety of SARS-CoV-2 Vaccinations in People with Multiple Sclerosis

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